NPIMap

Organization Active NPI

Southwest Georgia Rehab, Inc

  • Physical Therapist
  • Cordele, GA
National Provider Identifier
1902120587
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
005830 Issued in GA
Legal business name
SOUTHWEST GEORGIA REHAB, INC
Practice address
1107 Greer St Ste a-B
Cordele, GA 31015-1920
Phone
(229) 273-9445
Fax
(229) 273-9447
NPI assigned
Mar 25, 2010
Last updated
Jan 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacey A Hathcock, DPTNPI 1083816243
Title
Owner
Phone
(229) 273-9445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 005830 GA Primary
Occupational Therapist 225X00000X GA
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

1107 Greer St Ste a-B
Cordele, GA 31015-1920

Mailing address

1107 Greer St Ste B
Cordele, GA 31015-1921
Phone (229) 273-9445

Other practice location 1

1430 US Highway 82 W Ste 103
Tifton, GA 31793-8010
Phone (229) 445-3255

Other practice location 2

100 W Union St
Vienna, GA 31092-1055
Phone (229) 521-1152

Other practice location 3

201 W McPherson Ave
Nashville, GA 31639-2131
Phone (229) 445-7176

Other practice location 4

1001 Greer St
Cordele, GA 31015-2056
Phone (229) 207-4004

Other practice location 5

1556 E Forsyth St Ste A
Americus, GA 31709-3334
Phone (229) 815-3565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100610000420 GA Part B Supplier - Clinic/Group Practice 6204966740 Receives reassigned benefits from 26 practitioners
Practice locations: Cordele, GA; Nashville, GA; Vienna, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1556 E Forsyth St
Ste A
Americus, GA 31709
Phone (229) 815-3565

1001 Greer St
Cordele, GA 31015
Phone (229) 207-4004

101 E 4th Ave
Cordele, GA 31015
Phone (229) 928-2013

1107 Greer St
Ste B
Cordele, GA 31015
Phone (229) 273-9445

316 E 16th Ave
Ste A
Cordele, GA 31015
Phone (229) 273-3193

100 W Union St
Vienna, GA 31092
Phone (229) 273-9445

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768176000000",
    "number": "1902120587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 GREER ST STE B",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310151921",
            "telephone_number": "229-273-9445",
            "fax_number": "229-273-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 GREER ST STE A-B",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310151920",
            "telephone_number": "229-273-9445",
            "fax_number": "229-273-9447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 US Highway 82 W Ste 103",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317938010",
            "country_code": "US",
            "telephone_number": "229-445-3255",
            "fax_number": "229-445-3256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 W Union St",
            "address_purpose": "LOCATION",
            "city": "Vienna",
            "state": "GA",
            "postal_code": "310921055",
            "country_code": "US",
            "telephone_number": "229-521-1152",
            "fax_number": "229-521-1050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 W McPherson Ave",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "GA",
            "postal_code": "316392131",
            "country_code": "US",
            "telephone_number": "229-445-7176",
            "fax_number": "229-389-2645",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Greer St",
            "address_purpose": "LOCATION",
            "city": "Cordele",
            "state": "GA",
            "postal_code": "310152056",
            "country_code": "US",
            "telephone_number": "229-207-4004",
            "fax_number": "229-394-0031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1556 E Forsyth St Ste A",
            "address_purpose": "LOCATION",
            "city": "Americus",
            "state": "GA",
            "postal_code": "317093334",
            "country_code": "US",
            "telephone_number": "229-815-3565",
            "fax_number": "229-815-3568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST GEORGIA REHAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-25",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A",
        "authorized_official_last_name": "HATHCOCK",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-273-9445",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "005830",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordele, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.